Awake Brain Tumor Surgery: Current Anesthesiologic Concepts in Contemporary Practice

Abstract Awake craniotomy for brain tumor resection has emerged as a paradigm shift in neurosurgical oncology, allowing maximal tumor removal while preserving critical neurological functions. The present review examines current anesthesiologic concepts in awake brain tumor surgery, emphasizing the role of the anesthesiologist in patient selection, perioperative management, and neurological monitoring. A comprehensive literature search (2015–2025) was conducted to identify advances in anesthetic techniques, sedation strategies, and pain and complication management in awake craniotomy. Key factors such as meticulous patient selection, advanced anesthetic and analgesic techniques, intraoperative brain mapping, and multidisciplinary planning are highlighted. Awake craniotomy can achieve extensive tumor resection with reduced neurological deficits by enabling real-time functional testing during surgery. The anesthesiologist's expertise in maintaining patient comfort, airway control, hemodynamic stability, and rapid intervention for events like seizures is crucial. Modern approaches, including regional anesthesia, conscious sedation with agents like dexmedetomidine, and multimodal pain management, have improved patient tolerance and outcomes. By integrating careful preoperative planning, sophisticated intraoperative monitoring, and proactive postoperative care, awake brain tumor surgery can be performed safely and effectively.